Permissive hypotension in the extremely low birthweight infant with signs of good perfusion.

Hdl Handle:
http://hdl.handle.net/10147/206238
Title:
Permissive hypotension in the extremely low birthweight infant with signs of good perfusion.
Authors:
Dempsey, E M; Al Hazzani, F; Barrington, K J
Affiliation:
Neonatology, Cork University Maternity Hospital, Cork, Ireland.
Citation:
Arch Dis Child Fetal Neonatal Ed. 2009 Jul;94(4):F241-4. Epub 2009 Jan 27.
Journal:
Archives of disease in childhood. Fetal and neonatal edition
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206238
DOI:
10.1136/adc.2007.124263
PubMed ID:
19174413
Abstract:
INTRODUCTION: Many practitioners routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA). OBJECTIVE: To assess the effectiveness of utilising a combined approach of clinical signs, metabolic acidosis and absolute blood pressure (BP) values when deciding to treat hypotension in the extremely low birthweight (ELBW) infant. METHODS: Retrospective cohort study of all live born ELBW infants admitted to our neonatal intensive care unit over a 4-year period. Patients were grouped as either normotensive (BP never less than GA), hypotensive and not treated (BP<GA but signs of good perfusion; we termed this permissive hypotension) and hypotensive treated (BP<GA with signs of poor perfusion). RESULTS: 118 patients were admitted during this period. Blood pressure data were available on 108 patients. 53% of patients were hypotensive (mean BP in mm Hg less than GA in weeks). Treated patients had lower birth weight and GA, and significantly lower blood pressure at 6, 12, 18 and 24 h. Normotensive patients and patients designated as having permissive hypotension had similar outcomes. Mean blood pressure in the permissive group increased from 26 mm Hg at 6 h to 31 mm Hg at 24 h. In a logistic regression model, treated hypotension is independently associated with mortality, odds ratio 8.0 (95% CI 2.3 to 28, p<0.001). CONCLUSIONS: Blood pressure spontaneously improves in ELBW infants during the first 24 h. Infants hypotensive on GA criteria but with clinical evidence of good perfusion had as good an outcome as normotensive patients. Treated low blood pressure was associated with adverse outcome.
Language:
eng
MeSH:
Birth Weight; Blood Pressure/physiology; Decision Making; Gestational Age; Humans; Hypotension/diagnosis/physiopathology/*therapy; Infant, Extremely Low Birth Weight/*physiology; Infant, Newborn; Intensive Care, Neonatal/methods; Retrospective Studies; Unnecessary Procedures
ISSN:
1468-2052 (Electronic); 1359-2998 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorDempsey, E Men_GB
dc.contributor.authorAl Hazzani, Fen_GB
dc.contributor.authorBarrington, K Jen_GB
dc.date.accessioned2012-01-31T16:42:50Z-
dc.date.available2012-01-31T16:42:50Z-
dc.date.issued2012-01-31T16:42:50Z-
dc.identifier.citationArch Dis Child Fetal Neonatal Ed. 2009 Jul;94(4):F241-4. Epub 2009 Jan 27.en_GB
dc.identifier.issn1468-2052 (Electronic)en_GB
dc.identifier.issn1359-2998 (Linking)en_GB
dc.identifier.pmid19174413en_GB
dc.identifier.doi10.1136/adc.2007.124263en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206238-
dc.description.abstractINTRODUCTION: Many practitioners routinely treat infants whose mean arterial blood pressure in mm Hg is less than their gestational age in weeks (GA). OBJECTIVE: To assess the effectiveness of utilising a combined approach of clinical signs, metabolic acidosis and absolute blood pressure (BP) values when deciding to treat hypotension in the extremely low birthweight (ELBW) infant. METHODS: Retrospective cohort study of all live born ELBW infants admitted to our neonatal intensive care unit over a 4-year period. Patients were grouped as either normotensive (BP never less than GA), hypotensive and not treated (BP<GA but signs of good perfusion; we termed this permissive hypotension) and hypotensive treated (BP<GA with signs of poor perfusion). RESULTS: 118 patients were admitted during this period. Blood pressure data were available on 108 patients. 53% of patients were hypotensive (mean BP in mm Hg less than GA in weeks). Treated patients had lower birth weight and GA, and significantly lower blood pressure at 6, 12, 18 and 24 h. Normotensive patients and patients designated as having permissive hypotension had similar outcomes. Mean blood pressure in the permissive group increased from 26 mm Hg at 6 h to 31 mm Hg at 24 h. In a logistic regression model, treated hypotension is independently associated with mortality, odds ratio 8.0 (95% CI 2.3 to 28, p<0.001). CONCLUSIONS: Blood pressure spontaneously improves in ELBW infants during the first 24 h. Infants hypotensive on GA criteria but with clinical evidence of good perfusion had as good an outcome as normotensive patients. Treated low blood pressure was associated with adverse outcome.en_GB
dc.language.isoengen_GB
dc.subject.meshBirth Weighten_GB
dc.subject.meshBlood Pressure/physiologyen_GB
dc.subject.meshDecision Makingen_GB
dc.subject.meshGestational Ageen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHypotension/diagnosis/physiopathology/*therapyen_GB
dc.subject.meshInfant, Extremely Low Birth Weight/*physiologyen_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshIntensive Care, Neonatal/methodsen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshUnnecessary Proceduresen_GB
dc.titlePermissive hypotension in the extremely low birthweight infant with signs of good perfusion.en_GB
dc.contributor.departmentNeonatology, Cork University Maternity Hospital, Cork, Ireland.en_GB
dc.identifier.journalArchives of disease in childhood. Fetal and neonatal editionen_GB
dc.description.provinceMunster-

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